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. Author manuscript; available in PMC: 2024 Mar 1.
Published in final edited form as: Neurotoxicol Teratol. 2023 Jan 27;96:107162. doi: 10.1016/j.ntt.2023.107162

Factors associated with ever using cannabidiol in a cohort of younger pregnant people

Natacha M De Genna a, Stefanie Kennon-McGill b, Lidush Goldshmidt c, Gale A Richardson d, Judy C Chang e
PMCID: PMC9992243  NIHMSID: NIHMS1870905  PMID: 36717004

Abstract

One in four Americans have used cannabidiol (CBD) products in the past year, and use has become prevalent in many Western countries with recent deregulation from a controlled or illicit substance to an unrestricted product. CBD is also marketed to pregnant people to treat common medical conditions. However, preclinical work has linked cannabidiol exposure to embryotoxicity, as well as neuroendocrine, reproductive, and behavioral effects in offspring. No studies have examined the prevalence or correlates of CBD use among pregnant people. Demographic, medical, and psychosocial correlates of cannabidiol use were examined in the YoungMoms study, a cohort of pregnant people under the age of 22, a population that is at high risk for cannabis use during pregnancy. Few of the participants (n=186; 75% Black or Biracial) reported use of cannabidiol during pregnancy, but one in five had tried these products. Participants who reported ever using CBD were more likely to report alcohol and other drug use prior to pregnancy, controlling for race.As the use of CBD among people of reproductive age is increasingly prevalent, more research on CBD use in pregnant human populations is needed to investigate the effects of CBD on fetal development and infant outcomes.

Keywords: cannabidiol, CBD, cannabinoid, prenatal cannabis, pregnancy, prenatal

1. Introduction

Cannabidiol (CBD) is the most well-known non-intoxicating phytocannabinoid or psychoactive substance from the Cannabis sativa plant. After hemp products were removed from the definition of marijuana in the US Controlled Substance Act in 2018, CBD products began proliferating in the US market. Similar deregulation of CBD from a controlled substance to an unregulated or less regulated product has also recently occurred in the UK (Towobola et al., 2021) and Australia (TGA, 2020a). With the exception of Epidiolex™ (used to treat seizures for rare, severe forms of epilepsy), CBD products are neither approved nor regulated by the US Food and Drug Administration (FDA) (Knopf, 2020). However, one in four Americans have used CBD in the past year, primarily to treat anxiety, depressive symptoms, pain including headaches/migraines, and sleep issues (Goodman et al., 2022). CBD is marketed online and in retail outlets as a treatment for a variety of ailments, including those commonly experienced during pregnancy.

The science of prenatal CBD exposure is currently in its infancy (Knopf, 2020; Sarrafpour et al., 2020). Early animal studies that evaluated maternal exposure to a single 50 mg/kg dose of CBD or the related non-psychoactive cannabinol (CBN) found neuroendocrine and reproductive effects in the male offspring of rodent models (Dalterio & deRooij, 1986; Dalterio et al., 1984). While it has been shown that single doses of CBD are short-lived in the mother and the fetus and unlikely to accumulate over time (Ochiai et al., 2021), there is a growing body of evidence showing CBD may interfere with important placental mechanisms, including expression of P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) during gestation (Feinshtein et al., 2013a; 2013b). P-gp and BCRP are ATP-binding cassette transporters that are significant for drug transport throughout various organs, including the placenta. Thus, alteration in the expression of these transporters can have significant effects on drug transport across the placenta, which may affect the fetus. These data have clinical implications, suggesting that CBD exposure could affect xenobiotic transport across the placenta, and possibly expose the fetus to higher concentrations of xenobiotics for longer periods of time. In fact, Alves et al. (2021) demonstrated that CBD can cause dose-dependent interference of integral mechanisms of placental development, including autophagy, apoptosis, and trophoblast turnover, which could potentially have significant effects on the fetus.

Additional studies support a mechanism whereby CBD causes embryotoxicity. One dose-response study found that injection of CBD into chicken eggs led to dose-dependent effects on embryotoxicity at significantly higher levels than injection of vehicle. Injection of 5 μM CBD led to a 50% drop in viability, whereas a dose of 50 μM led to an 80% drop in embryo viability. However, it is important to note that it is unclear if the high dose injection is clinically relevant in the context of presumed fetal exposure in humans (Gustafsson & Jacobsson, 2019). An in vitro study found that exposure to CBD induced an increase in intracellular Ca2+ levels in oligodendrocytes, causing toxicity, and another study found that exposing human cell lines to low doses of CBD caused significant DNA damage and chromosomal aberrations (Mato et al., 2010; Russo et al., 2019). The results from these studies indicate a possible harmful role of CBD during embryonic development.

Based on the animal data, the US FDA, the UK’s Food Standards Agency (Towobola et al., 2021), and Australia’s Therapeutic Goods Administration (TGA, 2020b) advise against the use of CBD during pregnancy or while breastfeeding (FDA, 2019; FSA, 2020). However, no studies have documented the prevalence, correlates, or sequelae of CBD use in human pregnancy. Among non-pregnant populations in North America, past-year CBD use was associated with race (white), age (26–35 years), higher socioeconomic status, and recent cannabis use (Goodman et al., 2022). The demographic and psychosocial characteristics of people who use CBD during pregnancy is unknown. In Western European samples, individuals reported using CBD for their well-being, sleep, stress, and anxiety (Fortin et al., 2021; Moltke et al., 2021). Reasons for use during pregnancy were investigated in a survey of Californian women of reproductive age: 20–30% reported that they would use CBD to treat nausea, anxiety, and labor pain. Moreover, 20% of anesthesiologists and 70% of the doulas surveyed for the study rated CBD as safe during pregnancy (Selzer et al., 2019). In US states with legal recreational marijuana, dispensary staff (budtenders) may suggest CBD products to pregnant people seeking marijuana as a form of harm reduction (Barbosa-Leiker et al., 2022). However, no studies have examined correlates of CBD use during human pregnancy. Side effects of CBD have been noted in non-pregnant people, including liver toxicity, interactions with prescription medicine, drowsiness, and gastrointestinal discomfort (White, 2019).

The goal of this study was to extend the nascent literature on CBD in human populations by examining the prevalence and correlates of CBD use among pregnant people under the age of 22, a population that is at high risk for cannabis use during pregnancy (De Genna et al., 2015; Hill et al., 2022; Volkow et al., 2017). Based on Goodman et al. (2022), we hypothesized that CBD use would be more common in pregnant people who were white, older, and who used cannabis compared to those who were younger, not white, and abstained from using cannabis. In addition to the correlates of CBD use measured previously in non-pregnant populations, we investigated the link between CBD use and variables specific to pregnancy such as nausea/vomiting during pregnancy and pregnancy intendedness, desire, and timing. Based on the Selzer et al. (2019) study of women of reproductive age in California, we expected that nausea/vomiting during pregnancy and symptoms related to anxiety (e.g., stress, emotional distress) would be associated with use of CBD in this study.

2. Materials and Methods

The data for this analysis were collected during the baseline assessment for the YoungMoms project, a prospective, longitudinal cohort study of perinatal tobacco and cannabis use in pregnant people ages 13–21 in Pittsburgh, PA (R01DA046401). All pregnant patients within this age range who presented to Magee-Womens Hospital or an affiliated obstetric clinic for care were approached for recruitment at their first obstetric (OB) visit or a return OB visit if they had not been reached for their first visit. Women were called prior to their OB appointment and/or received a notice about the study at the clinic and, for those who expressed interest, a research team member provided more information, established eligibility, and obtained written, informed consent to collect data using a tablet or online survey. One clinical urine sample was also collected when a research staff member was able to meet the participant at their next OB appointment, which was tested for presence of cotinine and tetrahydrocannabinol (THC). Data for these analyses were collected between October 2019 and September 2021. Ethics approval for this project was provided by the Institutional Review Board at the University of Pittsburgh.

2.1. Participants

Inclusion criteria for the YoungMoms study include presentation to one of the university teaching hospital’s prenatal clinics (including affiliated clinics in the community) and 13–21 years of age with a confirmed pregnancy. Patients were excluded from the study if they were older than 21 and/or if they could not speak and read English well enough to provide informed consent and complete a tablet or online survey. Of the 608 OB patients approached about the study, 147 refused to hear about the study and an additional 124 spoke with a research assistant and then refused to participate in the study. Twenty-six patients consented to participate but did not complete the survey and 14 became ineligible for the study before they completed the survey due to pregnancy loss or early delivery. Data were not available for 6 participants due to technical issues with the survey. The survey was completed by 305 patients, but not all participants responded to the item about CBD use. Thus, the current analysis focuses on data from the 186 participants who reported on CBD use.

2.2. Measures

2.2.1. Cannabidiol (CBD) use

In the survey, participants were asked “Have you ever tried CBD, even once?” The following definition was provided after this question: “Cannabidiol (CBD) is a chemical from the marijuana or hemp plant that does NOT get you high. Some people use it like medicine.” If the participant responded “yes,” they were asked if they had ever smoked CBD, with the following forced-choice responses: “Yes, I smoke CBD now and smoked it before I got pregnant,” “Yes, but only before I found out I was pregnant,” “Yes, but only after I found out I was pregnant,” or “I have never smoked CBD.” Participants were then asked similar questions about vaping CBD, using edible CBD products, or CBD products in other forms (e.g., topical).

2.2.2. Other substance use

Participants were asked about cannabis use in the survey prior to being asked about CBD. The first question was “How old were you when you first tried marijuana/weed?” The following definition was provided after this question: “By marijuana/weed, we mean something to get high/baked – not CBD.” Participants who provided an age at first use were then asked what types of cannabis they had ever used, the quantity and frequency of types of cannabis used prior to pregnancy recognition, and the quantity and frequency of these types of cannabis after they found out that they were pregnant. Similar questions were used to collect data on tobacco and alcohol use. These data were used to create dichotomous variables for daily, near daily (4 or more days/week), weekly, and monthly use before and during pregnancy. The survey questions about different types of cannabis and tobacco included illustrative pictures such as drawings of combustible cigarettes and photographs of popular brands of little cigars and cigarillos. For other illicit drugs, participants who indicated any past use were asked if they had used those specific drugs since pregnancy recognition. The urine sample provided to the clinic by the participant at the OB visit when they were recruited for the study was also screened for cotinine and THC by research staff using point-of-care immunoassay testing. Due to restricted access to the prenatal clinics during the height of the COVID-19 pandemic, urine samples were only available for 107 of the participants in this analysis.

2.2.3. Covariates

All participants were asked about the number of people in the home who smoke marijuana, vape marijuana, smoke tobacco, and JUUL/vape nicotine. Other covariates included demographic characteristics, medical factors, and psychosocial characteristics. Participants self-reported demographic characteristics such as their age, race, Hispanic ethnicity, educational status, employment, job satisfaction, perceived employability, current housing situation, satisfaction with housing situation, and relationship status in the baseline survey. To measure ethnicity, participants were asked “Are you Hispanic/Latina?” with a yes/no forced choice response. To assess race, participants were asked “How would you describe your race (select one or more responses)?” with the following response options: Black/African American, white, Biracial, Asian, Other (specify).

Medical factors included the date of pregnancy discovery, parity, gravidity, and the presence and severity of nausea and vomiting (referred to in the survey as morning sickness). We also measured pregnancy intendedness, desire, and timing using an adapted version of the London Measure of Unplanned Pregnancy (Barrett et al., 2004), as these variables are linked to mental health and behavior in adolescent pregnancy (East et al., 2012).

Psychosocial factors included experiences of intimate partner violence (IPV) and mental health symptoms. IPV was assessed using three age-appropriate questions that were modified from the Conflict Tactics Scale-2 (CTS-2: Straus, 1996) and the Sexual Experiences Survey (Koss & Gidycz, 1985) to measure ever and past 3-month experiences with physical and sexual abuse. Mental health symptoms were measured using the 8-item PROMIS emotional distress screener (Pilkonis et al., 2011) and the 4item Perceived Stress Scale (PSS: Cohen et al., 1983; Warttig, 2013).

2.3. Statistical analysis

Individuals who reported ever using CBD were first compared with those who had not tried CBD using chi square test of differences for dichotomous variables (e.g., Hispanic ethnicity, any illicit drug use during pregnancy) and t-tests for continuous variables (e.g., age, frequency of cannabis use during pregnancy). Logistic regression was used to determine the relative strength of the association between cannabis use during pregnancy and CBD use, parsing out the variance accounted for by covariates that were significant in the bivariate analysis. To increase power, a model-building strategy was used with separate regression analyses conducted for demographic, medical, and psychosocial and substance use covariates. A final model was tested using the variables that were statistically significant in the previous regression models.

To check for desirability bias in self-reporting of cannabis use, the final regression analysis was repeated using a variable indicating a positive self-report of cannabis use during pregnancy or a clinical urine sample that was positive for THC. Due to the high rate of non-response to the CBD item in the survey, we compared those who responded to the CBD question (n=186) and those who skipped this question (n=119) on age, race, and substance use before and during pregnancy. Participants who skipped the CBD question did not differ in age, race, gravidity, tobacco or alcohol use before or during pregnancy, or pre-pregnancy frequency of cannabis use compared to those who answered the item. However, those who skipped the question were less likely to report weekly cannabis use during pregnancy (1% vs 35%) than participants who responded to the CBD question.

3. Results

3.1. Sample characteristics and prevalence of CBD use

Participants ranged in age from 14–21 years old (M = 19.7, SD = 1.7) and were predominantly non-Hispanic Black (75% Black or Biracial, 23% white, 2% Hispanic). Most were recruited during the first trimester (68%); 22% and 10% were recruited during the second or third trimester, respectively. Nearly one-third of the participants were enrolled in school and 40% were currently employed (17% part-time, 23% full-time). Sixty percent were primigravida and 29% had previously given birth. Forty (22%) participants reported that they had used CBD. Smoking was the most prevalent route of administration (17%), followed by vaping (7%), edibles (11%), and other (3%). Among participants who reported ever using CBD, 11 used CBD during pregnancy (6% of the sample): five smoked, three vaped, two used an edible form, and one used another form of CBD while pregnant.

3.2. Correlates of ever using CBD

Demographic, medical, and psychosocial correlates of ever using CBD from bivariate analyses are reported in Table 1. Ever CBD use was associated with older age, white race, not being currently enrolled in school, any morning sickness, history of IPV, and number of people in the household who smoke cigarettes or vape (cannabis or nicotine).

Table 1.

Demographic, medical and psychosocial correlates of CBD use

Never CBD
n=146		 Ever CBD
n=40		 p-value
Age (years) M = 19.6 M = 20.3 < 0.05
Race (% Black/Biracial) 81.5% 50% < 0.0001
Hispanic (%) 2.0% 2.5% ns
Gravidity (% 1st pregnancy) 61.3% 55.0% ns
Enrolled in school (%) 31.2% 15.0% < 0.05
Employment (% full-time) 21.9% 25.0% ns
Employment (% part-time) 18.5% 12.5% ns
Employability M = 2.7 2.5 ns
Satisfaction with housing M = 1.8 1.55 ns
Morning sickness (any) 81.2% 95.0% <0.05
Severity of nausea/vomiting M = 1.9 1.8 ns
Pregnancy intendedness M = 2.3 2.1 ns
Pregnancy desire M = 1.9 1.8 ns
Pregnancy timing M = 1.8 1.7 ns
IPVa (% ever) 15.2% 33.3% < 0.05
Emotional distress M = 17.0 17.7 ns
Stress M = 9.9 10.2 ns
Household cannabis smokers M = 0.49 0.75 ns
Household cannabis vaping M = 0.12 0.37 < 0.05
Household cigarette smokers M = 0.66 1.1 < 0.05
Household nicotine vaping M = 0.15 0.47 < 0.05
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a

IPV = Intimate Partner Violence

Bivariate relations between CBD use and other substance use are reported in Table 2. Ever use of CBD was significantly associated with ever use and frequency of tobacco, alcohol, cannabis, and controlled substances. Participants who reported trying CBD were also more likely to have clinical urine samples that tested positive for THC. The Phi coefficient between positive urine screen for THC and ever CBD use was 0.21.

Table 2.

CBD use and other substance use

Never CBD
n = 146		 Ever CBD
n=40		 p-value
Ever tobacco use (%) 30.8% 72.5% < 0.0001
Weekly tobacco use prior to pregnancy 21.2% 55.0% < 0.0001
Daily/near daily tobacco use prior to pregnancy 15.8% 50.0% <0.0001
Weekly tobacco use during pregnancy 14.4% 35.0% < 0.01
Daily/near daily tobacco use during pregnancy 6.2% 17.5% < 0.05
Ever vaping 20.5% 70.0% < 0.0001
Ever alcohol use 53.4% 87.5% < 0.0001
Monthly alcohol use prior to pregnancy 20.5% 57.5% < 0.0001
Ever cannabis use 39.0% 75.0% <0.0001
Weekly cannabis use prior to pregnancy 38.4% 67.5% =0.001
Daily cannabis use prior to pregnancy 24.7% 52.5% < 0.001
Any cannabis use during pregnancy 39.0% 75.0% < 0.0001
Daily cannabis use during pregnancy 10.3% 22.5% < 0.05
Ever illicit drug use 8.9% 55.0% <0.0001
Cotinine-positive urine test 54.3% 69.2% ns
THC-positive urine test 48.1% 73.1% < 0.05
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3.3. Multivariate models

The regression models predicting ever CBD use are depicted in Table 3. The first regression model tested demographic and psychosocial factors, identifying white race as the only significant predictor of CBD use.

Table 3.

Logistic regression models predicting ever using CBD

Model Variables R2 Beta Odds
Ratio		 Confidence
Interval		 p
Model 1 Demographic and psychosocial factors 0.18
Age (years) 0.22 1.24 0.9–1.7 Ns
Race (Black/Biracial) - 0.22 0.1–0.49 0.0003
1.53
School enrollment - 0.47 0.14–1.58 ns
0.75
Morning sickness (any) 0.92 2.51 0.52–12.11 Ns
Household nicotine vaping 0.57 1.76 0.99–3.13 0.054
Household cannabis - 0.97 0.64–1.48 ns
IPV (ever) 0.03 2.22 0.89–5.52 0.09
0.80
Model 2 Pre-pregnancy substance use 0.24
Daily/near daily tobacco use 0.96 2.63 1.03–6.72 0.04
Monthly alcohol use
0.98 2.66 1.09–6.47 0.03
Daily cannabis use - 0.97 0.37–2.57 ns
0.03
Ever illicit drug use 2.16 8.68 3.4–22.03 <0.0001
Model 3 Substance use during pregnancy 0.04
Daily/near daily tobacco 0.98 2.67 0.89–8.0 0.08
Daily cannabis use (selfreport) 0.75 2.11 0.81–5.47 ns
Model 4 Final model 0.28
Daily/near daily tobacco use before pregnancy 0.67 1.95 0.74–5.17 ns
Monthly alcohol use before pregnancy 1.45 4.28 1.58–11.57 < 0.005
Ever illicit drug use 1.79 6.0 2.17–16.63 0.0005
Race (Black/Biracial) - 0.20 0.08–0.54 0.001
1.60
Prenatal cannabis use (selfreport or positive urine sample) 0.25 1.28 0.45–3.61 ns
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The second regression model tested pre-pregnancy substance use, with tobacco, alcohol, and illicit drug use emerging as significant correlates of ever CBD use. The third regression model tested substance use during pregnancy, and neither tobacco use nor cannabis use during pregnancy were significantly related to ever CBD use. The final regression model included predictors that were statistically significant from the three prior models. In the final model, ever CBD use was associated with monthly alcohol use prior to pregnancy recognition, ever illicit drug use, and white race. Replacing self-reported cannabis during pregnancy with the combined cannabis variable (positive self-report or THC-positive urine sample) in the final model did not change the results.

4. Discussion

The prevalence of CBD use during pregnancy was low in this sample of younger women, but 22% of the participants had ever tried CBD products. The use of a model-building strategy allowed us to examine which predictors from demographic, psychosocial, and substance use domains were more closely linked to CBD use. Among the demographic and psychosocial factors, race emerged as the only significant correlate of CBD use, consistent with findings from an online survey of North Americans that people who identified as white were more likely to use CBD (Goodman et al., 2022). No pregnancy-specific variables were significantly related to CBD use. Pregnancy-related variables may be more relevant in populations with a higher prevalence of CBD use during pregnancy. In this sample, recent cannabis use (either prior to or after pregnancy recognition) was not significantly associated with ever CBD use, controlling for other types of substance use. However, history of CBD use was associated with alcohol and other drug use prior to pregnancy.

Although one in four US adults report using CBD products (Goodman et al., 2022), there is no prior research on the prevalence and correlates of CBD use among pregnant people. A survey of women of reproductive age from California found that 2030% might use CBD while pregnant to treat nausea, anxiety, and labor pain, indicating a high interest in prenatal use in states with more lenient marijuana laws (Selzer et al., 2019). However, rates of use were low in the current study, in a state with a very different legal landscape, and reports of nausea and vomiting during pregnancy were not associated with CBD use. It is possible that CBD use is more prevalent in US states with recreational marijuana laws, where healthcare providers (Selzer et al., 2019) and dispensary staff may be recommending CBD products to pregnant people using marijuana as a form of harm reduction (Barbosa-Leiker et al., 2022). The demographics of the current study sample were also not as likely to be at-risk for CBD use, based on Goodman and colleagues’ findings that the use of these products was more common among North Americans who were white, ages 26–35, with a higher socioeconomic status. One implication of our results is that it is necessary to study the prevalence, correlates, and effects of CBD use during pregnancy in pregnant people of all ages, especially those who are white and higher socioeconomic status.

In contrast to use of CBD during pregnancy, rates of cannabis use were high in this sample of young pregnant people. We found that 73% of the clinical urine samples from pregnant participants who reported ever CBD use were positive for THC, compared to 48% of those who had never tried CBD. Although pure CBD products are unlikely to result in a urine sample that tests positive for THC (Bergeria et al., 2022; Sholler et al., 2022; Spindle et al., 2020), it is possible that some participants whose urine samples were positive for THC inadvertently used CBD products with low doses of Δ9-THC (Bergeria et al., 2022; Dahlgren et al., 2021; Sholler et al., 2022). Nonetheless, 23% of those who had tried CBD reported daily cannabis use during pregnancy in the survey compared to 10% of participants who had never tried CBD products. However, neither regular cannabis use prior to pregnancy recognition nor self-reported prenatal cannabis use was significantly associated with history of CBD use once pre-pregnancy tobacco, alcohol, and illicit drug use were included in the model. This is in contrast to findings from the International Cannabis Policy study, where CBD use in non-pregnant individuals was linked to recency of cannabis use in a dose-response manner (Goodman et al., 2022). More research is needed on the frequency and quantity of different cannabinoids during different trimesters of pregnancy.

Although young pregnant people are significantly more likely to use tobacco products (De Genna et al., 2009; 2017; Graham et al., 2010) and cannabis (De Genna et al., 2009; 2015; Volkow et al., 2017) before and during pregnancy than older pregnant people, the younger people in this sample had low rates of CBD use during pregnancy. Participants who had used CBD products prior to pregnancy were more likely to have also used illicit drugs and legal substances that are contraindicated during pregnancy, such as tobacco and alcohol compared to those with never CBD use. Thus, CBD use may reflect a general predisposition to substance use rather than a tendency to use psychoactive cannabinoids, at least among very young pregnant people. Given the nascent animal literature on the effect of CBD on embryotoxicity (Gustafsson & Jacobsson, 2019; Mato et al., 2010; Russo et al., 2019) and placental mechanisms (Alves et al., 2021; Feinshtein et al., 2013a, 2013b) and the adverse effects reported in human populations (White, 2019), pregnant patients should be discouraged from using CBD while pregnant. Health care providers concerned about prenatal exposure to CBD should screen for prior history of substance use and remind at-risk patients of their local regulatory agency’s recommendations against the use of CBD products during pregnancy or while breastfeeding.

4.1. Strengths and limitations

This study has several strengths: It is the first, to our knowledge, to report the prevalence and correlates of CBD use in a pregnant population; to characterize CBD use in a population at higher risk of substance use during pregnancy; and to include detailed data on multiple types of substance use before and during pregnancy. There are also several limitations. Results may not generalize to pregnant people with different demographic characteristics, including people who are over 21 years of age, those of Hispanic ethnicity, and those living in rural areas. The study should be replicated using nationally representative data from a sample large enough to detect differences among subgroups. Another limitation was lack of data on all prescription medications, an important covariate in maternal-fetal exposure studies. Some consider self-reports of substance use during pregnancy as a limitation because it may be subject to recall bias and social desirability. However, a strength of well-characterized self-report is that it can capture patterns of substance use, including frequency, in contrast to biological assays that measure body burden at the time of sample collection. Biological assays are subject to a limited window of detection that is heavily influenced by the quantity, frequency, and recency of use, as well as metabolic considerations (Richardson, Huestis, & Day, 2006). To address this limited window of detection, we included a variable in the final multivariate model that was derived from a positive self-report or a positive urine screen for THC at an obstetric appointment available in a subsample of participants and found similar results. Thus, we are confident that cannabis use during pregnancy was not a significant correlate of CBD use in this sample, controlling for history of other substance use. An additional limitation is that many participants skipped the question assessing CBD. It is possible that these participants did not understand the question, despite the description provided in the survey. In fact, participants who did not respond to the CBD question were significantly less likely to report cannabis use than those who did respond. Lack of familiarity may have resulted in cannabinoid-naïve participants skipping this question. Future studies of cannabinoid use in pregnancy may consider using interviews, rather than surveys, to ensure more complete data and participant comprehension of all measures. In this study, we erred on the side of caution by restricting our analysis to those participants who responded to the CBD question, rather than recoding missing as non-users.

4.2. Conclusions

Pregnant people less than 22 years old may be less likely to use CBD products than those who are not pregnant and pregnant people who are older, despite higher rates of tobacco and cannabis use during pregnancy than in older individuals. One in five young pregnant people in this study had ever tried CBD products, predominantly combustible forms, and CBD use was related to tobacco and alcohol use prior to pregnancy, rather than cannabis use. The prevalence of CBD use during pregnancy was too low in this cohort to determine if it was related to nausea and vomiting during pregnancy or other pregnancy-related variables. The study should be replicated in a larger sample with older pregnant people, who may be more familiar with and likely to use CBD, as well as people from different racial and ethnic groups. Future research on CBD use in pregnant human populations should include both self-report and biological measures of CBD use and examine the effects of CBD on fetal development and infant outcomes.

Highlights.

  • There is little data on the prevalence and correlates of prenatal use of CBD.

  • One in five younger pregnant people (< 22 years) had used CBD products.

  • Lifetime CBD use was linked to alcohol and illicit drug use before pregnancy.

  • The prevalence of prenatal CBD use was low in this cohort.

  • Younger pregnant people are more likely to use products with THC.

Acknowledgements

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (R01DA046401). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

List of abbreviations

CBD

cannabidiol

CBN

cannabinol

FDA

U.S. Food and Drug Administration (US government)

FSA

Food Standards Agency (UK government)

IPV

Intimate Partner Violence

TGA

Therapeutic Goods Administration (Australian government)

THC

Tetrohydrocannabinol

Footnotes

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Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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